All them youngins’ got swollen heads

We referred a young, generally healthy patient for a CT scan a while ago. I can’t remember what we were investigating, but I do remember that she didn’t have any hard signs of cerebral oedema (brain swelling).

We (students) don’t challenge a radiology report. Most of us have deplorable radiological knowledge. Our consultant certainly didn’t agree though, scanned through the file and concluded that our healthy young patient had a perfectly normal brain as far as the eye could see.

He then explained why he thought the mistake slipped in:

At our hospital, the majority of patients sent for CT Brain Scans are being investigated for strokes, TB Meningitis or Cryptococcal Meningitis. These patients are thus mostly elderly and/or HIV-positive. Incidentally, these two groups commonly display cerebral atrophy. As a result, day in and day out, our radiologists are confronted by diseased, or at the very least atrophied, brains.

This has become their reference point, such that when they see a nice full brain, it appears swollen.

Interesting, no? You still won’t catch me eagerly challenging such a report though – consultants have radiological experience, I do not.